Country Club Dental Care

Primary specialty

DentistTaxonomy code 122300000X

License

11533 Issued in FL

Legal business name

COUNTRY CLUB DENTAL CARE

Practice address

214 Country Club Dr
Titusville, FL 32780-8605

Phone

(321) 269-1242

Fax

(321) 269-4477

NPI assigned

Nov 6, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

James W Wardner, D.M.D.

Title

Dentist

Phone

(321) 269-1242

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257465600000",
    "number": "1497082796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 COUNTRY CLUB DR",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327808605",
            "telephone_number": "321-269-1242",
            "fax_number": "321-269-4477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 COUNTRY CLUB DR",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327808605",
            "telephone_number": "321-269-1242",
            "fax_number": "321-269-4477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CLUB DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-06",
        "last_updated": "2009-11-06",
        "status": "A",
        "authorized_official_last_name": "WARDNER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "321-269-1242",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "11533",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "9681",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa Correa, ARNP
• Susanne Cortes-Morris, LCSW
• Emily D. Costello, NP
• Country Acres CH
• Country Acres Group Home
• Daphne C Courey, RPH
• Rebecca Christine Courtney, MA, BCBA
• Rebecca E Covert, LMT
• Ashley V Cox
• Patrick M. Craanen, ED.D., CCC-SLP

• Dentist in Titusville, FL
• Providers in Titusville, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.